Gliederung

Objective: Malignant tumors of the skull base are a rare and heterogenous group. Skull base metastases (SBM) with intracranial involvement representing a minority of those cases. In account of improved systemic therapies resulting in prolonged survival times of the primary tumor an increased number of SBM patients is expected. Here we focused on the effect of skull base surgery of SBM patients in a retrospective analysis.

Methods: All patients with SBM who had been operated on from 1996 to 2009 in our department were identified. A comprehensive characterization of neurological and surgical parameters was performed. Pre- and postoperative status as well as follow-up were determined by Karnofsky Performance Score (KPS) and Glasgow Outcome score (GOS).

Results: A total number of 21 patients with SBM (11 males and 10 females) underwent resection in our department. The median age at diagnosis of SBM was 61 years (range 24–72). The most common tumors are sinunasal carcinoma, lung and kidney. The median interval between the diagnosis of the primary site and the SBM was 25 months (range 0–120). The median survival was 6,5 months (range 0–166). The overall 1 year survival rate was 61,1%. The 5-year survival rate was 27,8%. The median tumor volume was 27 cm3 (range 1,5–210 cm3). In 10 patients we found distant metastases. 76% of SBM were located in the anterior fossa, 10% in middle fossa and 14 % in posterior fossa. 71% of all patients showed cranial nerve palsies. All patients had intracranial involvement of the tumor and underwent extended resections of brain infiltrating tumor areas. 10 patients underwent craniofacial resection in teamwork with ear nose and throat specialists. 25% of all patients had complications (2 CSF leakage, 1 epidural haematoma, 1 cerebral oedema, 1 stroke), in 10% resulting in a revision operation. Most of the patients (76%) had an unaffected KPS postoperatively. 8 patients are still alive with a median survival of 23 months (range 8–166) in that group.

Conclusions: Recent reports have shown complication rate of skull base surgery to be 33 to 55% with a significant adverse prognostic indicator of tumors involving the brain. In our series all patients showed brain involvement of the SBM and the overall rate of postoperation complication was 25%. We find a significant better survival rate of patients with sinunasal carcinomas. Significant prognostic predictors for overall survival are age younger 60 years and KPS > 60.